49: Ergonomic strain during robotic hysterectomy


      Nearly 90% of surgeons performing minimally invasive procedures experience musculoskeletal pain or discomfort. Surgeon discomfort has been associated with robotic hysterectomy; however, studies have mostly been limited to surveys. The aim of this study was to prospectively evaluate ergonomic posture and surgeon discomfort following robot hysterectomy.

      Materials and Methods

      This prospective cohort study was approved by the Mayo Clinic Institutional Review Board and included 6 gynecologic surgeons: 3 male and 3 female. All surgeons had performed over 100 robotic hysterectomies prior to this study. Each surgeon performed 3 robotic hysterectomies on a da Vinci Xi surgical system. Surgeons wore inertial measurement units (IMUs) on their head, chest, upper arms, and waist to objectively measure body posture during surgery. IMU sensors are equipped with accelerometers, gyroscopes, and magnetometers to measure movements of the area on which they are placed. The Modified Rapid Upper Limb Assessment (RULA) is a 0-4 scale used to determine no risk (0-1), mild (1-2), moderate (2-3) and high risk (3-4) ergonomic positions using the neck, trunk/back and shoulders posture as measured by the IMUs. Validated questionnaires were administered pre- and postoperatively to measure surgeon musculoskeletal discomfort.


      Mean age of the surgeons was 44.9 ± 9.8 years. Mean hysterectomy duration was 39.8 ± 13.7 minutes. Of the 18 robotic hysterectomies performed, surgeons reported no pre- or postoperative pain in 4 (22.2%) cases, pre- and postoperative pain in 7 (38.9%) cases, and no preoperative pain with new postoperative pain in 7 (38.9%) cases. Out of the 18 cases, the most common areas of surgeon-reported new or increased postoperative discomfort were: right shoulder (7), back (7), right wrist (6), left wrist (5), and neck (5). The IMU data revealed that of the 18 robotic hysterectomies, 12 (66.7%) of the cases put the neck at no to mild risk. The trunk/back was at no to mild risk in 7 (38.9%) cases and mild to moderate risk in 11 (61.1%) cases. The right shoulder was at no to mild risk in 17 (94.4%) cases, and the left shoulder was at no to mild risk in all 18 (100%) cases (Table 1).


      Nearly 40% of surgeons experienced worsened musculoskeletal pain following robotic hysterectomy. Objective data showed that in nearly all cases, surgeons were at risk of ergonomic strain.
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